RCT Results: What is the Optimal Timing for Dinoprostone Prior to Office Hysteroscopy?
BACKGROUND AND PURPOSE:
Evidence regarding prostaglandin use (e.g., misoprostol or dinoprostone) for pain relief in the setting of office hysteroscopy is conflicting
Lack of consistency may be due to different dosing intervals
Rund et al. (Journal of Minimally Invasive Gynecology, 2021) sought to determine the optimal timing of vaginal dinoprostone administration before office hysteroscopy in nulliparous women
Randomized, double-blinded trial
Undergoing office hysteroscopy
Long interval dinoprostone
3 mg administered vaginally 12 hours before hysteroscopy
Short interval dinoprostone
3 mg administered vaginally 3 hours before hysteroscopy
Pain during hysteroscopy: Measured on 100-mm visual analog scale (0=no pain; 100=worst pain imaginable)
Ease of hysteroscope passage
Patient satisfaction score
Drug side effects
Long interval: 90 women | short interval: 90 women
Long-interval dinoprostone had lower pain scores during hysteroscopy (P<0.001)
Long: mean (SD) pain score 36.2 (8.1)
Short: 51.9 (10.5)
Mean difference -15.7 (95% CI, -18.4 to 12.9)
Pain scores 30 minutes post-procedure were similar in both groups (P=0.1)
Long: 28.1 (9.0)
Short: 31.3 (18.1)
Mean difference -3.2 (95% CI, -7.4 to 1.0)
Long interval dinoprostone was associated with
Greater patient satisfaction (P<0.001)
Easier hysteroscope passage through cervical canal (P=0.003)
Shorter procedure duration (P<0.001)
Side effects were comparable in both groups
Vaginal dinoprostone administration to nulliparous patients 12 hours vs 3 hours prior to office hysteroscopy reduced pain and was also associated with higher patient satisfaction, easier hysteroscope insertion, and shorter procedure duration
The authors suggest that while this RCT proves “the time-dependent efficacy of vaginal dinoprostone administration for relieving pain in nulliparous women” undergoing office hysteroscopy, they also advise
Future studies should also compare dinoprostone timings in other study populations such as postmenopausal women and include comparative placebo groups to the active study groups
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan